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Anemia treatment through the years.

Article Excerpt
Q: What types of treatments for anemia were available for patients prior to the use of erythropoiesis-stimulating agents (ESAs)?

A: The treatment of anemia was greatly impacted by the introduction of ESAs in 1989. Treatments prior to that time were relatively ineffective with numerous side effects. Anemia is an almost universal complication found in patients with chronic kidney disease (CKD) and is associated with adverse outcomes. It develops early in the disease, and all individuals, regardless of stage or cause of kidney disease, should be evaluated for anemia. As destruction of kidney tissue progresses, the degree of anemia increases. Current recommendations indicate that evaluation should be done at the following hemoglobin concentrations: less than 13.5 g/dL in adult males and less than 12.0 g/dL in adult females (National Kidney Foundation [NKF], 2006).

Adverse Effects of Anemia

A common physiologic consequence of anemia is decreased oxygen carrying capacity of the blood with resultant tissue hypoxia. A compensatory mechanism is an increase in cardiac output, resulting in an increase in mass and contractile strength in the heart. Anemia is related to the progression of cardiovascular disease, including left ventricular hypertrophy, congestive heart failure, and ischemic heart disease in patients with CKD (McCarley & Burrows-Hudson, 2006). Other negative consequences include decreased physical function and stamina, fatigue, impaired cognition, sexual dysfunction, and decrease in quality of life. Anemia is also associated with increased hospitalization rates, morbidity, and mortality rates (Breiterman-White, 2007).

Early Treatment of Anemia

Although all adverse effects of anemia were not known in the early years of chronic dialysis, attempts at the correction of anemia were part of the treatment plan. These included blood transfusions and the use of anabolic steroids.

Blood Transfusion

Early on, anemia was primarily managed by blood transfusions given on a regular basis every 2 to 3 weeks (Fricke, 2006). These increased the patient's risk of infection, including transmission of diseases, such as hepatitis B and C, and HIV, since testing of blood for these substances was not fully developed at that time. Transfusion over time can also suppress endogenous erythropoiesis and lead...

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